Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #102511

Sarita Malik Bhalotra, MD, PhD¹, Donald Shepard, PhD², Gail K. Strickler, MA³, and Grant A. Ritter, PhD². (1) Schneider Institute for Health Policy, Heller School, Brandeis University, 415 South Street, MS 035, Waltham, MA 02454, (2) Schneider Institute for Health Policy, Heller Graduate School, Brandeis University, Mail Stop 035, Brandeis University, Waltham, MA 02254-9110, 781-736-3975, shepard@brandeis.edu, (3) Schneider Institute for Health Policy, Heller School for Social Policy and Management, Brandeis University, MS 035, 415 South Street, Waltham, MA 02454-9110

Implementation of the LMPD was studied at many of the 28 Ornish and 11 MBMI sites nationwide over a four-year period. At the end of 55 months (96% of the enrollment period), only 401 Medicare beneficiaries (11% of the target) had enrolled at the 39 sites nationwide, with 114 in Ornish and 237 in MBMI. MBMI provided less central support and oversight for both clinical and managerial activities than Ornish. The Ornish program was substantially more demanding to program sites and participants. A complex interplay of barriers to enrollment were identified at patient, provider and organizational levels; key were senior leadership support for the program, physician buy-in and referral, other insurance support, program personnel characteristics, synergistic relationship with cardiac rehabilitation), demands on participants, ease of eligibility determination. These impediments occurred at multiple levels, and needed to be addressed through multi-pronged and interconnected strategies and tactics. Clinical, managerial, and political support were essential. Patient resistance to participation might benefit from social marketing. To improve health status and control costs of treating chronic illnesses, it is imperative that the health care system promote lifestyle modification. Unless health care policymakers and program planners learn more about the challenges, barriers and incentives for engaging in multi-component lifestyle modification programs and ways to overcome them, such efforts are likely to incur huge costs while providing little benefit to the overall population in need. Benefits that are complex in design and delivery will be difficult for organizations to implement, providers to employ, and patients to utilize.

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